Neck lumps + other

Question 1

Differential diagnosis for midline neck mass

Answer 1

• Submental reactive lymphadenopathy
• Plunging ranula
• Thyroglossal cyst
• Thyroid mass (goitre)
• Pharyngeal pouch

Question 2

Differential diagnosis for lateral neck mass

Answer 2

• Reactive lymphadenopathy
• Lymphoma
• Salivary gland enlargement
• Branchial cyst
• Cystic hygroma
• Carotid aneurysm
• Thyroid mass
• Cervical rib

Question 3

A 75 year old man presents with dysphagia and halitosis. On the left side of the neck is a small, fluctuent swelling which gurgles when palpated.

Answer 3

Pharyngeal pouch

Question 4

A 54 year old woman presents with a neck swelling. She is systemically well apart from some recent weight loss. On examination she is noted to have a midline, non-tender swelling which moves upwards when she swallows.

Answer 4

Goitre

Question 5

A newborn baby is noted to have a large swelling on the left side of the neck. On examination a soft, fluctuent and highly transilluminable lump is noted just beneath the skin.

Answer 5

Cystic hygroma

Question 6

A 19 year old man presents with a swelling on the left side of his neck. On examination he has a smooth swelling in between the sternocleidomastoid muscle and the pharynx. It is fluctuent but doesn’t transilluinate or move during swallowing.

Answer 6

Branchial cyst

Question 7

A 28 year old Bangladeshi woman presents with a three day history of sweats, headache, lethargy and muscle aches. On examination she has bilateral tender swelling in the submandibular region.

Answer 7

Reactive lymph nodes

Question 8

A 17 year old girl presents with a painless swelling in the neck. She is currently well. A midline, cystic swelling is noted in the region of the hyoid bone. It moves upwards when she swallows or sticks out her tongue.

Answer 8

Thyroglossal cyst

Question 9

What is the most common cause of neck swelling?

Answer 9

Reactive lymphadenopathy

Question 10

Rubbery painless lymphadenopathy

Pain when drinking alcohol (rare)

Night sweats and splenomegaly

Answer 10

Lymphoma

Question 11

Pulsatile lateral neck mass that doesn’t move on swallowing

Answer 11

Carotid aneurysm

Question 12

A 64 year old woman with a one week history of pain above and lateral to her left eye. On examination she is tender over that area.

Answer 12

Temporal arteritis

Question 13

A 62 year old woman presents with a two week history of shooting pains across her left cheek. The pain is sometimes triggered by touching her face. She has no past medical history of note.

Answer 13

Trigeminal neuralgia

Question 14

A 42 year old man wit a 3 month history of chronic cough presents with a persistent headache.

Answer 14

Sinusitis

Question 15

Complications of thyroid surgery

Answer 15

• Anatomical such as recurrent laryngeal nerve palsy
• Bleeding (due to the confined space haematoma’s may rapidly lead to respiratory compromise)
• Damage to the parathyroid glands resulting in hypocalcaemia

Question 16

You are the foundation doctor on call for the surgical ward. A 65 year old male is six hours post thyroidectomy. You are bleeped and asked to review this man because of worsening stridor. When reviewing the notes, it is apparent the operation was uneventful. The surgeon’s notes describe adequate intraoperative haemostasis and closure using sutures.

What is the most appropriate management for this patient?

Answer 16

Urgent removal of sutures and call for senior help.